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. 2011 Jun;18(6):1717-22.
doi: 10.1245/s10434-010-1493-2. Epub 2011 Jan 5.

Primary hyperparathyroidism patients with positive preoperative sestamibi scan and negative ultrasound are more likely to have posteriorly located upper gland adenomas (PLUGs)

Avital Harari  1 , Elliot Mitmaker, Raymon H Grogan, James Lee, Wen Shen, Jessica Gosnell, Orlo Clark, Quan-Yang Duh
Affiliations

Primary hyperparathyroidism patients with positive preoperative sestamibi scan and negative ultrasound are more likely to have posteriorly located upper gland adenomas (PLUGs)

Avital Harari et al. Ann Surg Oncol. 2011 Jun.

Abstract

Background: Standard preoperative imaging for primary hyperparathyroidism usually includes sestamibi scanning (MIBI) and ultrasound (US). In a subset of patients with a positive MIBI and a negative US, we hypothesize that the parathyroid adenomas are more likely to be located posteriorly in the neck, where anatomically they are more difficult to detect by US.

Methods: We retrospectively reviewed the records of 661 patients treated for primary hyperparathyroidism between 2004 and 2009 at a tertiary referral center. We included patients who for their first operation had a MIBI that localized a single lesion in the neck and an US that found no parathyroid adenoma. We excluded patients with persistent or recurrent hyperparathyroidism, and patients with MIBIs that were negative, that had more than one positive focus, or that had foci outside of the neck. Sixty-six cases were included in the final analysis.

Results: A total of 54 patients (83%) had a single adenoma, 4 (6%) had double adenomas, and 7 (11%) had hyperplasia. Thirty-three patients (51%) had a single upper gland adenoma; 19 of these (58%) were posteriorly located upper gland adenomas (PLUGs). PLUGs occurred more often on the right side than on the left (P = 0.048, Fisher's test). PLUGs were also larger than other single adenomas (mean 1.85 vs. 1.48 cm, P = 0.021, t-test). Seventy-six percent of patients successfully underwent a unilateral or focused exploration. Six patients (9%) had persistent disease, which is double our group's overall average (4-5%).

Conclusions: Primary hyperparathyroid patients with preoperative positive MIBI and negative US are more likely to have PLUGs.

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Figures

Fig. 1
Fig. 1
Distribution of single adenoma glands
Fig. 2
Fig. 2
Sestamibi scan of a right-sided, posteriorly located upper gland adenoma
Fig. 3
Fig. 3
Algorithm to determine the most efficient approach to find the gland
Fig. 4
Fig. 4
Distribution of single-gland adenomas (n = 54)
See this image and copyright information in PMC

References

    1. Shabtai M, Ben-Haim M, Muntz Y, et al. 140 consecutive cases of minimally invasive, radio-guided parathyroidectomy: lessons learned and long term results. Surg Endosc. 2003;17:688–691. doi: 10.1007/s00464-002-9198-7. - DOI - PubMed
    1. Carroll MF, Schade DS. A practical approach to hypercalcemia. Am Fam Physician. 2003;67:1959–1966. - PubMed
    1. Pasieka J. Asymptomatic primary hyperparathyroidism. In: Duh QY, Clark OH, Kebebew E, editors. Textbook of Endocrine Surgery. 2. Philadelphia: Elsevier Saunders; 2005. pp. 419–493.
    1. Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med. 2005;35:266–276. doi: 10.1053/j.semnuclmed.2005.06.001. - DOI - PubMed
    1. Taniegra ED. Hyperparathyroidism. Am Fam Physician. 2004;69:333–339. - PubMed

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